Toxic epidermal necrolysis treated with plasma exchange in three patients receiving maintenance hemodialysis

Abstract

Plasma exchange (PE) against toxic epidermal necrosis (TEN) has been recognized as one of the therapeutic options, but its efficacy in patients with TEN who require maintenance hemodialysis remains unclear. Herein, we reviewed our experience of three hemodialysis patients with TEN in our hospital. Case 1 involved a 72‒year‒old woman with end‒stage kidney disease (ESKD) of unknown etiology who had received hemodialysis for two years and was admitted at 23 days after administration of meropenem hydrate to treat an abscess around the kidney complicated with renal cell carcinoma. Her TEN severity score was 6. Intravenous methylprednisolone (IVMP) and intravenous immunoglobulin (IVIG) therapies were performed, and then five sessions of PE using albumin preparation were also provided. However, she subsequently died of sepsis. Case 2 involved a 79‒year‒old woman with ESKD due to unknown etiology under hemodialysis for seven years who was admitted at 2 days after the administration of amoxicillin to treat fever of unknown origin. Her disease severity score was 4. Three sessions of PE using an albumin preparation after the administration of IVMP and IVIG resulted in a favorible outcome. Case 3 involved a 74‒year‒old woman with ESKD due to autosomal dominant polycystic kidney disease who had received hemodialysis for one year and was admitted 4 days after the administration of phosphomycin for a leg ulcer. Her disease severity score was 4. Four sessions of PE using fresh frozen plasma after the administration of IVMP improved her condition. Taken together, TEN in patients requiring dialysis tends to be severe； therefore, multidisciplinary management consisting of strong immunosuppressive therapy and PE is considered to be critical.